Control and Being a little Legislator

I have realized that I can't control anything, and I'm trying to live with that.

This is as much a psychological milestone as it is a spiritual one. Human beings can't influence most of what happens to them: we can't change the weather, we can't change history, and we can't change the people around us or their choices. Christians embrace this like they embrace the inevitability of suffering: they see that God has made it a way to go to Him.

It's refreshing to admit I can't control a lot. As a doctor, I can't control who will page or call me and whether it means I get out of bed on call. I can't control who will walk into my clinic or how long they'll need to talk about it. I can't control who will come into triage or the ED and whether they'll need a complicated workup or a surgery that day. At the most extreme: I can't control how placentas and cancers grow and I can't stop babies and women from dying. There's a vulnerability that can be exhausting (another patient? I already need to see twelve. Another ultrasound? Another phone call?). It's hard to maintain generosity and avoid being lazy. Also increasingly since residency is the inability to control my body: I can't just stay up as long as I want--my body turns off after 36 hours on and I miss meetings that I schedule after that.

The doctor-patient coin has two sides. I can't control how my doctor interprets the evidence on re-scoping versus empiric titration. I can't control what she'll find on that colonoscopy, either. I can't control what the meds will do, I can't control whether I develop extraintestinal manifestations, and I can't control whether or when I'll lose my colon or get cancer. (I also can't control the past, which includes a lot of knowledge about UC that I sort of wish I didn't have.)

And there are a scattered other few things. I can't control whether my siblings will stay Catholic, whether my married friends will stay married, whether my archdiocese will close my parish, whether the state will stop payment from CMS to my hospital....

There are some things that I can control a little more, but always weasel out of my grasp. I can't always seem to control the cleanliness of my apartment. Sometimes it looks like six frat boys live there and I can hear my German-standard cleanliness mother (who had us wipe the microwave and oven doors as part of the list of things to do with the dishes) tsking in my mind. Mom, I think I've wiped the oven once and vacuumed three times since moving here.

Then there are the things I wish were in my control and might be in my control, but I don't think my will is disciplined enough. These are all the parts of the life of virtue that I think I could do better on, even though my life now in residency tempts me to excuse all kinds of stuff. I have to learn to live like a saint even while working my current schedule. What if I died in residency? What will be my excuse that I didn't possess my own heart in each moment, form my conscience, and use every opportunity to love God and calmly grow in virtue?

But my old approach to virtue doesn't work now. (Lots of people said this about med school, that they're undergrad method of studying didn't work in med school. I didn't have to make that transition from TAC, but perhaps it'd have been better if I did, because I'd have recognized this need for something new sooner.) I can't legislate little changes any more. 

In med school, I wanted to be able to floss every day, so I made a little law for myself, invented a method for predisposing myself, created positive self pressure (a dental appointment), and unconsciously created negative pressure (shame). And it worked. The same thing worked for a lot of pious practices and projects. Now I can't get myself to floss, even though I applied all the same interventions. The same problem exists for a lot of my pious practices and projects. I don't know why this is, but I have a strong hunch: the core battle of my life, chronic exhaustion, makes it hard to pressure myself to do things. There's not enough energy for sustained enforcement upon myself. 

But the other day I had a realization. Considering the relationship between myself and God, I am never the legislator. God makes the laws and He stands under the reality in which I exert my free will with His help. This helped me realize what doctors of the Church and saints have long known: all that is needed for holiness is to follow one's conscience in each moment. When each opportunity to floss presents itself, I accept His grace and take care of my body. And because God's will is less totalitarian than man's, I might even decide (shocker) that flossing is not indicated in certain situations. (Do you floss after 30 hours at work? I fall into bed.)

How to Raise your Children so They Want a Catholic College

Thomas Aquinas, reading.

A real liberal education is very different from most college educations, and one in a Catholic setting is even more formative. I credit TAC with saving my soul in many ways. 
Recently someone asked me how my parents managed to get me to want that.

I think there are many paths to places like TAC, Wyoming Catholic, UD, Christendom, UST, Benedictine, and Steubenville. Some of my classmates (especially professors' kids) went to liberal arts grade and high schools. They heard philosophical discussions at home and heard about these colleges from a young age. Some of them got a "leg up" from this approach, but I could tell that others were a little tired of it.
 Other classmates were nontraditional, coming to liberal arts after a more typical college education, or being sent there by a religious order to discern whether they were called to marriage. 


I and most others had a middle road. My parents were confident that their faith was the truth. They discussed objective truths and common sense at dinner in ways I found normal, not schoolish. My parents were strongly involved in the pro-life movement. Even though I was involved in secular sports and hobbies, my parents helped form my opinions when groups went awry (like the Girl Scouts) or when movies were inappropriate.

Most importantly for me, my parents helped me read. We had so many books! We had fiction and nonfiction for every kid's taste. My parents read to us and we read to them. I devoured secular science fiction, fantasy, historical fiction (everything but romance). There were also bibles, encyclicals, and books on the saints on the shelves, but I went to truth via fiction. It was a short step from the Chronicles of Narnia and The Man who was Thursday to Mere Christianity and Orthodoxy. 

But each child is different. I have a sister who went to truth through logic. She loved to read, too, but she loved arguing and problem solving. I have a sister who didn't like to read as much, but loved to play and spend time with people. My fourth sister loves to write, and my parents were good listeners. 

Finally, it comes down to love. If you can show your children that there is love and that there is an objective truth, they can want to follow you on the good path. It may not even matter if they get a liberal arts education--hundreds of saints were uneducated, and most of my siblings are getting or got traditional college degrees. 

Elevator Speeches

Here are my quickie explanations for some of my countercultural choices. If someone really wants to know what I think, I tell them without holding back, in a way I think they'll understand.

Not prescribing contraceptives

Credit: euthman

I counsel about everything, but there is enough cell biology to make me think human organisms form at sperm-egg fusion that I don't like the post-fertilization effects of hormonal contraceptives. Barriers are harder to find a problem with, to be honest, but sex at its best is a total gift of one person to another, and barriers block some of that gift. I know it's not a perfect world, but (not to be crass) I want everyone to have sex at its best and I think not having that has bigger ripple effects than we think.

Opposing abortion
There are a lot of people personally affected by abortion, and I don't know where you stand. I can't pretend I understand any particular person's story but I can at least speak to the science that I tried to delve into. There is enough cell biology to make me think human organisms form at sperm-egg fusion, but that's the easy part. If we think there's an organism with human DNA formed at fertilization, the hard question is, when do we protect it like we protect the mom? When we're potentially talking about--ending of millions of protectable human life--I say we should be cautious. 

Offering NFP

I really think women should learn about all their options, and the quality of the evidence that supports each of them. There are fabulous numbers attached to several fertility awareness-based methods, but we need to acknowledge that these studies haven't passed through the rigors of statistical significance, peer review, and FDA approval.

Being a Christian

I believe there is a truth, something objective that exists and that is right and wrong. If you think that, you realize that truth has staying power, which is why fads and memes slip away so fast. One of the things with the greatest staying power is a two thousand year old story of a man who reportedly rose from the dead to save sinners. I'm a sinner, and I thought that staying power was something worth looking into. The rest can't fit into an elevator speech.

Being a Catholic

History leads to Catholicism. You can tell that men writing in the early decades and centuries A.D. were very identifiably Catholic. The reason why I'm Catholic isn't because I love the customs, the people in the hierarchy, or the feelings I get. It's because I love Christ and I see that this is the Church He founded.

Being a consecrated virgin
The Jewish idea of the people of God as the bride of God really flowered within the Catholic faith, and in the early centuries there were women married permanently to God. That rite is used today, and it's a beautiful life.


This post was a draft for a long time, because it takes me a lot of introspection and lived experience to encapsulate things that are this controversial and this important to me. Hope this is helpful!

A Licit Device to Prevent Pregnancy?

Credit: eglisetraditionaliste.org

Every few years the story about the "nuns in the Congo" that a pope (usually it's Bl. Pope Paul VI) said could take birth control resurfaces. Inevitably there are debunkers and rebunkers. It's very hard to find original documentation on this question, even in the age of the internet, because it was apparently all internal memos from theologians.

The story causes lots of confusion, but probably shouldn't because A) there was more estrogen in pills back then, so they probably were all truly anti-ovulant, B) it wasn't known that pills could even be contra-gestive or abortifacient, and C) emergency contraception (i.e. anti-ovulation or anti-fertilization in nonconsensual intercourse) is even now viewed as legitimate in Church teaching.

Nevertheless, every time the story arises, I think to myself: what sort of intervention could be licit in such a situation?

The problem is this: I need effective pregnancy prevention without post-fertilization effects. An ideal intervention would be anything that prevented fertilization only, such as something that inhibited cervical fructose production, capacitation, or the acrosome reaction. Of questionable permissibility would be something to inhibit the zona reaction (preventing the thick rind of chemicals around the egg from hardening), which would allow polyspermy and lead to a nonviable embryo. If life begins at sperm-egg fusion (which I find compelling) then allowing polyspermy would allow some viable embryos to become nonviable due to increased chromosome content.

But none of that technology exists. Just considering existing technologies, the most effective preventative devices are hormonal, but the only licit ones are barriers, and those mostly rely on male cooperation (or don't prevent STDs, like the diaphram). Hormonal strategies are illicit because they have post-fertilization effects. Going back to the doses of estrogen that pills contained in the time of Pope John XXIII is unsafe for women.

What I'm about to say does not come from an ethicist, a Church official, or even someone with a real degree in theology. 

A diaphragm. Just for clarity: the Catholic Churchis very clear that barrier contraceptives like
diaphragms are gravely sinful in marriage.

So, I guessed, maybe I need a barrier with hormonal-but-not post-fertilization effects. Maybe (this sounds really uncomfortable but hang on) a diaphgram plus or minus a cervical extension designed to go to (but not past) the endocervical os. The device could have a very, very low concentration of  levonorgestrel in it, so low that it had only autocrine effects on the cervical crypts only, and not on endometrial tissue or ovaries. Perhaps levonorgestrel would have too long a half life, and we'd have to synthesize a shorter-acting progesterone or one that had a long half life in an inactive form, then a short half life in an active form.

The result would probably be a ton of mechanical cervicitis. But (maybe) no postfertilization effects and effective pregnancy prevention. You could decrease the rate of cervicitis by using it only during your fertile window. (And maybe the diaphragm part of it could include a BBT thermometer component so that the device itself could tell you when to take it out, or an app connected to the device.)

But is this a good thing? Is it a crutch that would just act like another LARC, or would it help women (especially those who learned to chart so that they could use it only 5-10 days a month)? Would it drive us even deeper into the culture of death by helping people in absurd states (e.g. these women and this woman), or would it help lift us out, until we're more ready for the ideal of everyone-married-and-using-NFP?

And where do I go now? The patent office, or the confessional?

A Limit to to Primary Care?

Ever wonder why the pictures of offices are so weird? Me, too.
Somebody put some better free media on wikimedia, please.

As a future specialist, I'm struggling with letting go of primary care. As a pre-med and medical student I got frustrated when my OB/GYN didn't refill my albuterol for mild intermittent asthma. In response, I promised myself that I would not forget basic medicine.

The other day in continuity clinic, I saw a woman with a few medical problems. I wanted to do her age-appropriate USPSTF screening, which is germane to primary care. I had to look up the recommendations because I don't do a lot of screening and immunizations. I care for a single sex population which is largely of reproductive age, and my anticipatory guidance and lifestyle modifications are almost always about pregnancy and sexual behavior.

But I like being a responsible doctor, so I've modified my well woman templates based on age and USPSTF and CDC recommendations. I've built in HEADS screens for adolescents and breast and colon cancer risk scores for older patients. I remember how to read EKGs and do when I order them. I remember how to read chest X-rays and do when I order them. And I know the first few options for medical therapy for the most common problems: community-acquired infections, hypertension, diabetes, obesity, asthma, hypothyroidism, depression, early heart failure, and high cholesterol. I can respond to a heart attack or a stroke.

I'm not pretending I could be a successful family medicine or internal medicine resident. I have to look up the screening recommendations every time. I don't remember or know more than half of the medications they use, I'm sure. I can't ever remember the childhood milestones and immunizations. Don't look to me when someone's in kidney, liver, respiratory, or late heart failure. Find someone else for the endocrinology zebras and for the love of the patient, please have someone else run the code.

But I can look up what the evidence says when I have a well woman exam. So I looked up the tests I was supposed to order. When I went to staff the patient, my generalist attending scrapped most of my plan. "There's a limit to how much primary care we can do," she said.

This made me sad. Most of these women don't have another doctor. If they do, I begin to wonder why that other doctor can't do their pap tests (until things get surgical). I wish women only had to see one doctor unless they had more advanced medical problems. I enjoy continuity of care and building the physician-patient relationship. I find preventative screening a fascinating topic and a very satisfying intervention to execute. I love discussing lifestyle modifications because they knock at the door of virtue.

That said, I'm heading for fellowship and leaving primary care further and further behind. I think that primary care is an excellent sphere for midlevel practitioners, even though I love it.

In the future, there will certainly be a limit to how much primary care I do. If I become an MFM, I will do basically zero primary care and I will rely on specialists to help me manage the medical problems for my high risk patients with heart disease and other problems. (I'll still manage plenty of hypertensive disorders, obesity, diabetes, and thyroid disease myself.) That's a little hard to swallow, but I still dream of extending myself by joining a multidisciplinary practice that can be a hub for a woman's healthcare, so she doesn't have to spread out her time, energy, and medical records.

Coping with Ulcerative Colitis

Credit: Hummuskiller

I am writing this as I am drinking four 450cc barium sulfate containers for an MRE. It's disgusting, and the Crystal Light is not helping.

I didn't realize that I had anything to work out mentally or emotionally with UC. It's mild, it's moderately controlled, and I'm used to big life shifts (getting a chronic disease doesn't hold a candle to becoming a doctor). But in the past few weeks I've had two experiences that showed me how lonely UC has made me, and have helped me.

I was on L&D and was getting ready to do a C-section. I clicked into her chart and saw that she had UC. It always makes me feel a little bit of companionship. The C-section was with one of our pricklier attendings, Dr. M. Of all our attendings, she is the most challenging: she once asked me if I listened to patient's lungs after I'd ruled out PE (hard to explain if you don't get that). As the section proceeded I nicked an arteriole. "Are your cases always bloody?" she asked derisively.

I decided to be silly about it, since the patient was under general anesthesia. "Very," I replied. "It's always awful." To my surprise, Dr. M grinned at me. Had I cracked Dr. M? We continued to banter back and forth as we opened the abdomen. By baby time, we were chatting amicably.

"Bummer that she had to get general," Dr. M observed as I anchored my hysterotomy repair. "It was her platelets, from her methotrexate. Come on," Dr. M went on playfully, "can't you tie better than me? Me with my arthritis?"

"You have arthritis?" I asked softly. Arthritis in a surgeon is a bit of a sensitive subject, because your career is in your hands. When you're mask to mask over an abdomen, few people in the OR can hear you, so I asked quietly.

I guess I
should have
this here for
me? Or Dr. M?

"My gosh, it's gotten so bad in the past few years," she muttered. "The colitis is better, though."

My eyes grew wide. "You have ulcerative colitis?" The word "colitis" doesn't go with the word "arthritis" unless someone is talking about UC, or a very unlucky and uncharacteristic type of Crohn's.

Dr. M. looked up from the field and met my eyes. "Yeah, I have ulcerative colitis," she said.

"Me, too." I said. I completely forgot I was operating, I forgot about anything except for Dr. M. Here we were, operating across from each other and on a patient with our condition.

Dr. M turned her attention (and mine) back to the fascia. "I remember once when I was a resident in the middle of a 72. We worked the whole weekend then. And there was a vag hyst to do, and I felt so bad that I asked the third year to do it. And she made such a stink about it."

I was amazed. A "vag hyst," or vaginal hysterectomy, is a gem among procedures for OB/GYN residents. For a senior resident to give away a vag hyst, she must have felt terrible. (Like, interferon-soaked, uncontrollable diarrhea and tenesmus terrible. Sort of like I feel now that I'm in the middle of the fourth barium dose.) I didn't say anything and we went through the rest of the C-section quietly. There was a companionship that didn't need words. I was flooded with a strange relief.

Someone else knew what is was like to have UC as an OB/GYN resident. Someone knew what it feels like to be rounding and to suddenly need to find a bathroom that people don't mind smelling. Several times as an intern I had over ten patients to see and in the middle of them I suddenly had to go down a flight of stairs and into a guest bathroom, the only one I know of where people won't complain about a BM.

The second experience isn't as much of a story. I have scishow and vlogbrothers on Feedly and clicked on this Hank Green video because it seemed medicine-related. To my surprise, Hank Green has UC. Unsurprisingly he has really smart things to say about it. That's all for now; I can't finish this last barium bottle, but it's time to get the MRE. (Thankfully, there's glucagon in the near future to make me feel better.)

Blogging = Self-Publishing (It Doesn't Count)

I like to think about bioethics, theology, and the philosophy of medicine. I like to write about them on this blog. But I realized a few months ago that burying my essays in a blog is no good. I'm not saying this blog is a waste of time. It's a useful outlet for a verbal processor (me) and a nifty window for a few others to see into the life of a resident. It's also been a tiny hub for OB/GYN residents and students who want to practice according to their consciences.

Having come to this conclusion, I will keep sketching out my thoughts here, but I will no longer keep my thoughts limited to this page. This blog is exactly what the subtitle says: it's my experience. It's an open diary. That's why there are stories, schedules, and random cooking and ulcerative colitis posts.

But to be productive, scholastic dialogue has to happen in existing, professional avenues. That means NCBQ, LQ, Obstet Gynecol, and AJOG. And to be useful, advice on conscience has to be more accessible and more generalized. And that means I'm very excited to announce that I'm helping with a new project. It's called Conscience in Residency, and it's a single place for students, residents, PhDs, and even pharmacists to go for practical advice in following their conscience. (It's technically going live tomorrow, so be excited that I gave you first peek.) Apart from telling you I helped in CIR, I won't ever announce a publication, to protect anonymity. Bummer! Publications are major parties. Maybe every time I publish I'll just put up a picture of fireworks, 0-30 randomly-generated days after acceptance or epub or print? Would that be vain?

This also means you'll see disappearance of a few posts that are being rewritten for publication, or have been published. Sorry if the blog gets a little disorganized and links die! (Rest in peace, links.)

The "Safe Harbor" Idea is a Myth

I am going to apply for a fellowship that doesn't involve contraception. Am I running away?

There are several fellowships off generalist practice that could try to circumvent prescription of contraception. One could to MIGS, and only be a women's surgeon (sometimes management of endo could leave you in a tricky spot). One could to gynecologic oncology, and only operate and give chemo on women with cancer (safest bet, but hardest to get). One could do MFM, and only take care of people who are already pregnant (postpartum concerns especially in the heart failure patients becomes tricky). Am I running away by seeking one of these?

I don't think so. I want to do MFM for another reason: my interest in early pregnancy, ectopic rescue, and placentation. I love complex physiology. I love crises and encouraging women through them. I love life and protecting it. I am going into MFM to bolster the research that supports the embryo and the fetus as a person. I'm doing it to be more effective as a pro-life physician.

It bothers me when people assume I'm doing MFM to avoid contraception. At the same time, I can't hide the fact that it's rather convenient that MFM means my scope of practice isn't as restricted.

A few people I've told about this decision are very happy with it and give the response that makes my skin crawl. "Oh, so the contraception think won't be much of an issue. It's like a safe harbor." I hate being called a coward. (It's too close to the truth, anyway.) Besides, I'm not really escaping anything. MFM is soaked with termination and sterilization. What kind of escape is that? In order of most to least protective, it goes Onc > MIGS > MFM. 

I also dislike that Catholics should have to seek a "safe harbor." We should be able to practice in any field. If we have limits, we're like 100% of other physicians, and we are fortunate (?) to live in a country where the things we don't provide can be provided by someone else. I shouldn't have to go hide in internal medicine or surgery (I thought about it!). I should be able to be an OB/GYN. If we all ran away into safe harbors, who would witness to the truth? Who would challenge the paradigm?

Not only the "safe harbor" idea fundamentally flawed, but it's also a myth. There is no safe place to be a physician who trusts his conscience more than he trusts his lawyer and the guidelines of his professional organization. In the coming decades it will be a growing challenge for anyone who wants to do the right thing, whether or not he plans for a safe career.

Chapel Veil Story

A few Fridays ago I got off early and went out to one of the monasteries for Mass. Too late I remembered that on Friday the conventual Mass was in the morning, not the evening. On my way home, I decided I might as well scope out the 24-hour adoration prospect I'd heard about at a parish near my house. I couldn't remember where it was and used some Google and GPS to find it. But it turns out that there are two St. Paul parishes in my diocese, and so by the time the whole evening was over I'd been to three churches.

And somewhere along the way I lost my chapel veil. I remained blissfully unaware of this fact until I got ready for Saturday evening Mass, which I was scheduled to cantor. My whole parish knows I wear a chapel veil, so I began to be irritated when I couldn't find it. "They'll all wonder why I'm not wearing it," I muttered as I turned my car and apartment upside down, "especially in the sanctuary...."

Eventually I gave up. God apparently wanted a dose of humility that day, and a lesson to keep a closer eye on my belongings! After all, the counsel of poverty encourages me to treat everything I own as borrowed from a highly respected friend.

My parish is an average 21st century parish: there is no basket of veils as in TLM communities. I went to the church ready to go bareheaded. I was the first one to arrive and started to flick lights on in the sacristy. Then an older couple entered, not dressed for Mass, and carrying boxes and bags. "Excuse me," said the woman in a quiet voice. "Are you a sister?"

The fabulous Jen Fulweiler veiling.

"I'm a consecrated virgin," I said smiling. "It's quite similar. What can I do for you?"

She held up the box in her hands. "Father John told me to knock on the door and to bring these in. My mother died and she left some items to the parish."

I helped her and her husband carry the things into the sacristy. She seemed a little reticent but asked me to open the box. "There are some weird things in there," she said, sounding embarrassed, "like those covers that women used to wear."

"The lace veils?" I asked.

"Yes."

Oh my goodness, I thought. This is so perfect. "Do you mind," I asked timidly, "if the parishioners use the veils?"

"No," said the woman. "That's what she gave them for, I suppose."

The woman and her husband left, and I opened the box. There were three black lace veils. (For any not familiar with the custom of veiling, unmarried women wear white, and married women wear black. This is analogous to nuns and sisters wearing white veils during their formation and black veils after they take vows.)

I'm not married, I thought. That was the reason why I retained my white veil: the only person in a church to wear a white veil and a ring should be a consecrated virgin or a sister who is part of an order without a habit. To veil in black is laden with meaning. It says: I am not available the same way, I now belong, I am absorbed by a husband and family.

But perhaps He is telling me that I am not available, I am absorbed like that. I wore the black veil at Mass. It was very strange: I've never veiled in black.

It made me think, though, about my relationship with Christ. How am I acting like a wife? St. Therese was once motivated to love God more by seeing a devoted newlywed wife. Shouldn't I act just as committed, just as completely taken, as a wife?

So for right now, I'm veiling in black. It's happened to me before that I've lost spiritual articles for very good reasons. (The best example I can think of is losing my Little Office of the Blessed Virgin Mary in college, a story for another day.) Perhaps this, too, was a good loss.

I am noticing more and more that I need to allow God to love me, to receive His grace, to be attentive to His wishes. I am drawn closer to the contemplative part of my vocation: more prayer, more practice of recollection. Being absorbed in Him doesn't exclude good works, but it does change my availability for them. 

Cognitive Disorders

Medical training and life in general is overflowing with cognitive mistakes. I've been meaning to blog about them since fourth year of medical school. Here are ten common cognitive mistakes; look how close to the truth each one is. (This is reprinted from some handout I got some time in med school. If I'm plagiarizing, let me know and I'll take it down.)

1. All-or-nothing thinking: you see things in black-and white categories. If your performance falls short of perfect, you see yourself as a total failure.
2. Overgeneralization: you see a single negative event as a never-ending pattern of defeat.
3. Mental filter: you pick out a single negative detail and dwell on it exclusively so that your vision of all reality becomes darkened, like the drop of ink that discolors the entire beaker of water.
4. Disqualifying the positive: you reject positive experiences by insisting that they "don't count" for some reason. In this way you can maintain a negative belief that is contradicted by your everyday experiences.
5. Jumping to conclusions: you make a negative interpretation even though there are no definite facts that convincingly support your conclusion.
1. Mind reading: you arbitrarily conclude that someone is reacting negatively to you, and you don't bother to check this out.
2. The fortuneteller error: you can anticipate that things will turn out badly, and you feel convinced that your prediction is an already-established fact.
6. Magnification (catastrophizing) or minimization (also called "the binocular trick"): you exaggerate the importance of things (such as your goof-up or someone else's achievement), or you inappropriately shrink things until they appear tiny (your own desirable qualities or another person's imperfections).
7. Emotional reasoning: you assume that your negative emotions necessarily reflect the way things really are.
8. Should statements: you try to motivate yourself with "should" and "shouldn't," as if you had to be whipped and punished before you could be expected to do anything. "Musts" and "oughts" are also offenders. the emotional consequences are guilt. When you direct "should" statements toward others, you feel anger, frustration, and resentment.
9. Labeling and mislabeling: this is an extreme form of overgeneralization. Instead of describing your error, you attach a negative label to yourself. "I'm a loser." When someone else's behavior rubs you the wrong way, you attach a negative label to him. "He's a louse." Mislabeling involves describing an event with language that is highly colored and emotional labeled.
10. Personalization: you see yourself as the cause of some negative external event, for which in fact you were not primarily responsible.

Three Quick Takes

ICU and STEP 3 and ACOG, oh my! Abstracts are due in August for ACOG, which means I am trying to accomplish too many things this month. Therefore, short posts on topics that I've been meaning to blog about forever. (There are only two of them, it's not even that exciting.)

1: Nursing is Cooler than You Think

Seriously, how cool is it to be a nurse? Doctors are kind of like prima ballerinas: they come onstage when everything else is ready and everyone is waiting for them. Then they do their thing and let everyone else wrap up and finish everything. (This is especially true of surgeons in the OR. They're paged when the patient is asleep and positioned and they gown/glove, do their thing, and leave afterwards and let the staff +/- resident take care of everything from closing to recovery.) Nurses, on the other hand, are with the patient, advocating for them. 

And the profession of nursing more closely resembles what we are meant to do in salvation history. God is the physician: He alone has the knowledge that heals us. But He lets us assist: he lets us nourish and spread His gifts, in our own souls and in others'. Nursing is an image of what saints and angels do for sinners.

I know I am in the right vocation. But now that I am working with nurses and that I know someone in nursing school, I'm thinking so much more about this. Nursing is so cool.

2: Awesome! The Linacre is On Pub Med! And a Dilemma

I seem to be able to make a dilemma out of anything. It's really good news that the Linacre Quarterly, the journal that has been published by the Catholic Medical Association since 1934, is now archived in PubMed. It's a mark of legitimacy, and research that gets archived there is shared with the general scientific community. I'm much more attracted to publishing there, since any articles that appear will have a PMID and a real DOI.

Linacre is also growing more professional, with a new format (as of like eleven months ago, I'm super late blogging this) and more scientific research to balance its many essays, book reviews, and philosophical and theological reflections.

But the dilemma is: do I publish new research in the Linacre or do I publish it in a professional journal? (I'm a little embarassed as a I write this, because it's all hypothetical...I haven't got a single abstract to speak of.) It'd be so awesome if some big important paper put Linacre on the map. But I don't want to hid all my findings in the Catholic corner--today, who would take a paper published in a Catholic journal seriously? Am I being career-centered or just practical? Gah.

3: Why I Don't Have Pets

Some consecrated virgins have pets, both to keep them company and to keep them from thinking about themselves all the time if they live at home. I currently have no pets. I'm not allergic to them and I think they're adorable. And my parents' house has seen all kinds of pets: birds, fish, gerbils, mice, chinchillas, cats, and a dog (not simultaneously).

But now is not the time for pets. Let me explain. I dog-sit for friends occasionally. Their adorable terriers are affectionate, well-behaved, and clean. But last night while dog sitting I burned the midnight oil researching the ethics of emergency contraception. The dogs snoozed while I stayed up with my laptop. But then, five and a half hours into my sleep, they woke up and needed a walk. Dogs don't understand fides quarens intellectum. They just need to lick your face and chase some squirrels.

So, for now, while I burn many midnights studying OB/GYN and medical ethics, no pets. (Also, I don't really want to become the old cat lady. I'm on my way to becoming the old church lady already.)

Easter Fire: In Which God has a Laugh

I notice things; maybe you do this, too. Maybe you always know where the fire exits are. Maybe you notice the elderly priest at Mass and think about what you would do if he fell or fainted. Maybe you notice the pregnant lady in the car next to you and think about what you would do if she got in an accident (maybe you even keep a scalpel in your car to do a stat C-section...).

Easter fire. (Stock photo, obviously not the situation I was in.)

I think it's neat that I can notice these things and be ready. But sometimes I think God makes fun of me for it, just to keep me humble.

I worked days this past Easter, but I had the nights off. So, after I got off on Holy Saturday I drove to an abbey not far from my city for their midnight Easter Vigil. It was going to be my rest: for just a few hours, I had no responsibilities. I didn't have to cantor, talk to people, or even stay awake! Thank God, I prayed.

This is the abbey where I made my week-long retreat before my consecration. It was an otherworldly week, partially because the abbey really lives the vow of poverty and the life of silence. Each member lives in a tiny (6x10ft) hermitage without heating or air conditioning. They also have foundations in Africa, and they live the same way on both continents. 

Given this spirit, I wasn't surprised to see a make-shift, but lovely credence table for the lighting of the paschal candle. In a broad stew pot were some coals, and this was placed on top of a cheap card table, covered with a white tablecloth.

I felt strange coming back after so many months in the world. I was then more than halfway through intern year: I was a competent, resident, I paid bills and bought stuff, and I was neck-deep in ethical questions, all far from ethereal prayer. That night, I re-entered the world of silence feeling like an outsider.

I slid in a few minutes early next to another woman. It was hot (remember: no air conditioning), and she had brought a water bottle. The plastic crackled in the monastic quiet before Mass. When the time came to light the candle, we all stood. Because I'd slid in the back, I was only a few feet away from the humble credence table. An acolyte poured some lighter fluid on the coals and clicked a lighter. My face and the faces of the whole back row were illuminated, and I felt even more exposed. Hide me, God. Please, just let me cower in the back and absorb the Mass.

All was well for a few minutes. Then the fire blew out of the pot and the tablecloth caught fire. The same sense of duty that makes me notice pregnant and elderly people was immediately awake: DO SOMETHING, it said.

What? I thought immediately. God, are you joking? 

The seraphic abbot and acolytes all stepped away in refined surprise. Inwardly, I groaned playfully at God, because it was as though He was nudging me lovingly. It had only been half a second since the fire started, and I grabbed my neighbor's water bottle, tore the cap off, and emptied it onto the table. There was just enough to put out the fire. I have residency to thank for the reflexes, and God to thank for His sense of humor.

Another July 1

Another July 1 is here, and this time I am a second year. It's bizarre to watch another cadre of interns come in, especially ones I knew as medical students.

It's a strange experience to think, after a long workday on July 30, "I'll be a second year tomorrow." I'll hold the ER pager. I'll do the crash repeats (the emergent C-sections on people who've had C-sections before) and the crash classicals. I'll run the list. I'll do the MIGS cases.

Last year, I heard people saying to the second-years, "see how much you've learned?" I know more than the new interns, but I don't know how much. I still haven't finished my Gabbe. I still haven't studied the things I missed on CREOGs (in-service exams during residency).

Before I start romanticizing a little too much, let me say: it's not as abrupt a change for me. I'm doing my ICU month first, so I'm still an acting intern this July. Even so, the difference between me and the medicine interns is dramatic. I know how to put in orders, I finished my note 15 minutes before rounds (and theirs still aren't done), I know how to present a patient. Even though I'm the off-service rotator, I was the one called to do the emergent new patient, because most of them still needed  help from the R3 for orders. (Not that big a deal though, the R3 came in to assess vitals with me...and it was even something I know how to deal with--acute anemia.)

But it's interesting.

I'm studying for STEP 3 this month. This is the last exam I will take before I have a medical license to practice independently. It's not the last exam I will take in my life, because I want to be board certified in OB/GYN, which means CREOGs and Boards (final exam at the end of residency to make sure I can start a job) and periodic recertification. STEP 3 is a two-day long multiple-choice test, with some (apparently) weird formatting in questions to simulate real-time case management of acute patients. I'm not super excited.

I think I'm a calmer person and I can now recognize when a person is really sick, and when a pregnant woman is really uncomfortable. I think I'm becoming a good doctor. I see a lot of potential in my career and the future seems bright. I still expect the day when I will make my first Big Mistake, the one that will make me look back on this time wistfully, wishing I could go back. I don't fear having adverse outcomes; I only fear causing them.

There's a very important blog post coming up, one about faithfulness to calls. And that's all for today, because the ICU attending (who is a complete genius) is expecting me to present on neuroleptic malignant syndrome in an hour.

Three Words: Rode the Bed

There's been a paucity of stuff on the blog lately because it's suddenly really tiring to blog. After the huge burst of energy that rose up in answer to the challenges of intern year, I am at an emotional, cerebral, and spiritual low tide.

But these human tides are a natural phenomenon, so this is no surprise. In the mean time, I might do some more simple blogging. Today, I'll tell you a cool story that will take no research or soul-searching. This blog was originally designed to be a story repository so that I could write a book like Danielle Ofri or Perri Klass. So here's a story.

I was in triage seeing a patient with a hypertensive disorder of pregnancy. I had some questions about her management and my chief agreed, so she came over to talk with the patient about management options. I went to the next bay to see the next patient. She was a slender woman in her late second trimester, but there wasn't much time to smile and get to know her. She was obviously in pain: she moved around the bed holding her stomach. As I introduced myself I reached for her abdomen. It was taut, like a basketball.

This shows a single loop of prolapsed cord.
My patient had a whole bunch of loops and a four centimeter cervix

She was in so much pain that I left the room and came back with an ultrasound, immediately concerned for abruption. I scanned her quickly: no abruption that I could see, but her cervix was definitely open. And there was definitely a loop of the umbilical cord going through it. I used color to highlight the cord in the cervix. (The picture on the right.)

That is a very bad situation. Luckily, my chief was closer than she'd ever been all week: right next door. (Typically, she'd be over in L&D, which is a minimum ten-second walk if you go briskly.)

Not bothering to walk out of my patient's room and knock next door, I called my chief while setting up sterile gloves and a speculum. "Gina," I said, "I have a cord next door."

This is a funic presentation. The essential difference is that cord is
not through the cervix outside of the amniotic sac.

"A cord" is a euphemism for "a prolapsed cord," which is an obstetrical emergency. My chief immediately stopped her conversation with the hypertensive patient and she was in the room the next minute. She repeated my scan. "Spec her," my chief said, "it could be a funic presentation."

My very ginger pelvic exam revealed naked loops of cord outside of the cervix. I angled the speculum towards Gina. "Elevate the presenting part," my chief said gravely. "We're going to the back."

A little background: when the cord falls out of the uterus first, the baby can asphyxiate. So, we push up the presenting part of the baby (i.e. the head if the head is down) to take pressure off the cord. Then, the person pushing up rides the bed with the patient as we go back for a C-section, which is the only way to deliver the baby without impinging on the cord in the vagina. Interestingly, my chief and I had just gone over management of obstetric emergencies like this the day before. It was all very academic and educational then; now, it was very real.


This patient was still on a triage cot. In a single motion. I raised the foot of the bed and knelt on it, my hand still elevating the fetal head. The nurse was meanwhile unplugging everything from the triage bay walls: the fetal monitor, the O2 saturation monitor, and the tocometer. She flipped the brake and the cot slowly began to roll down the hall to the operating room.

We picked up quite a speed as we approached the 90-degree turn into the OR hall. I almost fell off the cot! (Thank goodness for side-rails.) As we rolled into the OR, someone put a hat on me and stuffed a mask into my free hand. I knelt on the floor next to the OR table and continued to elevate the presenting part as the patient was placed on the OR table, as a foley catheter was placed (yes), and as general anesthesia was induced.

"Can you feel pulsations in that cord?" asked my chief.

"All I feel is her shaking right now," I shouted from underneath the drape. The patient was shaking from her general anesthesia.

"Skin!" I heard from above me. That's the signal that a C-section is starting: the surgeon calls "skin" and "uterus" so that the nurse can chart time to delivery. Within a few seconds, I felt the pressure of the baby's head disappear. "You can come out now," called my second year.

I extracted myself from underneath the drape. I discovered that someone had attempted to put shoe covers over my clogs while I was genuflecting on the floor. I fixed them awkwardly as I walked over to a computer to put in orders for a PCA for after the general anesthesia wore off.

To ride the bed is an adventure in residency, a tale you tell to lower levels like a grandfather's fishing story. And I got to do it as an intern!

Intern Year in Review

I'm on clinic this month, which means I work 40 hour work weeks (not including weekend calls, of course). That means that there's time to blog, time to reflect, and time to improve.

It's also June, which means that my intern year is basically over. In fact, in the last two weeks of June I am no longer an intern, strictly speaking, because I take 24-hour calls after the R4s leave.

These are all the hours I've logged. The months of night float show up as inverted
compared to all the day shifts. Vacations look like black barcodes across entire days.

I have myself delivered 196 babies (50 of them by C-section, with me as surgeon), and been present for many more deliveries. I've done 19 hysteroscopies, one laparoscopic hysterectomy, a small handful of laparoscopic salpingectomies and cystectomies, and five cystoscopies. I've also paid off two of my undergrad loans. (Don't get excited; in true Dave Ramsey style, I paid off the littlest ones first, and there are still eight to go.)

It was a year of lessons and losses. I lost a lot of my expectations for the way my life would go, and I also lost some battles in living my vocation to the fullest. Now that my schedule is lighter, I'm taking some time to re-evaluate how my life should be lived. The biggest items I've identified are:

1. I need to protect times for confession, spiritual direction, and spiritual reading. All of these get eroded when three out of four weekends are eaten by call and weddings, and the fourth weekend feels like Chore Festival.
2. I need to care for my body, with enough sleep and with a diet heavy in fruits and vegetables to protect myself from emotional carb-loading.
3. It takes work to prepare for good quality prayer and recreation. I need to do this work ahead of time so that I don't veg through time without real contemplation and leisure.

In short: more than limiting the extras, I need to focus on protecting the most important things.

Please pray for me: I am preparing a chapel to house the Blessed Sacrament, and am seeking the privilege of keeping my Spouse at home with me.

Exhausted!

ex·haust·ed

iɡˈzôstəd/

adjective

1. 1.

   drained of one's physical or mental resources; very tired.

   "I was cold and exhausted"

   synonyms:

   tired out, worn out, weary, dead-tired, dog-tired, bone-tired, ready to drop, drained, fatigued, enervated; More

2. 2.

   (of resources or reserves) completely used up.

   "Karl spat, his patience suddenly exhausted"

   synonyms:

   used up, consumed, finished, spent, depleted; More

I'm spent. All four weekends of March and three out of four weekends in April I was out of town or working (and that free weekend in April I worked one call shift). I can point to two days in those two months on which I had no obligations to others (3/7 and 4/24). I am empty.

Even on my month of gynecology, which should be an easy month, I get home tired and all I want to do is eat, drink tea, and watch Rhett and Link.


I'm recovering now and it's good to recover. I'll be getting back to the regularly scheduled programming soon!

Objections (and New Sidebar Gadget)

"You live at a breakneck pace. It stresses me out."

"How can you be a good consecrated virgin with all this work?"

"How can you be a good doctor when you're doing these side projects?"

The first objection comes most often from my body. Ulcerative colitis and residency don't play together well. A UC colon loves a predictable schedule, well-cooked and wholesome food eaten slowly. Those things are basically impossible in OB/GYN residency, where I'm eating quickly between triage patients and deliveries and trying not to have an episode of diarrhea during a C-section.

The second and third objections come from my conscience. I work a lot, and not by choice. I worked 2430 hours in the 244 days between July 1 and February 29. That's 11.6 hours for six days a week, with a seventh day off (and includes the days I was not at work while on vacation). I'd like for things to calm down so that I can focus more time on my relationship with Christ. I could work to the bone my entire life and never get to know the man who saved me and stooped to make me his little consecrated virgin. That would be a horrible tragedy.

I am also pursuing several projects on the side, including a video (done with shooting by the time this comes out!), a set of brochures (should be done with this one completely by the time this post hits), home improvement, blogging for two sites (including this one), keeping up the scholastic life (which includes writing and submitting essays to various journals), research (don't remind me about the phone calls I have to make for my research right now...), and attempting to network with others fighting for the culture of life (which involves archdiocesan events, meeting people for dinner and coffee, and emails). How can I take care of patients when I am so tired and have to finish all these notes so quickly? How can I study and be a good learner when I'm trying to get four doctors with crazy schedules to Chicago to shoot a video?

I just thought this picture was funny.

My response to these? Part of me argues that I'm in a rare time in my life when I can spring back from fatigue after working these hours, and I can spend this much energy on things. But the other part of me completely concedes that the objections are true and I'm doing it all wrong. 

It's unrealistic to respond by promising I'll never go to another pro-life or pro-family event, or that I'll never write another paper. I need to establish a new balance of work, leisure, and prayer.

Part of being less overwhelmed is beginning to assume that the duties of adult life (taxes, car maintenance, housecleaning) are not a project and are just like brushing teeth: no big deal, just gotta do it.

The other part is limiting my projects. I used to limit myself to five active projects in medical school. This may sound like a lot, but I remember when I said "no" to eleven awesome-sounding opportunities in one week. It was a good lesson: not everything that sounds awesome is really important to a career (much less to a life). I'd like to introduce you to a new side-bar gadget: the Project Kitchen. I'm not allowed more than two active projects, with up to four on the back burners.

Behold the Wood of the Cross

It's now time to tell another story I was afraid to tell for a long time.

Although I was loud in college about ethics, I became a coward by the time my second year of medical school was half over. I never explained it on the blog. I let it seem spontaneous. But in reality, it had a clear beginning, during our Reproductive Sciences block.

I was trying to start a pro-life group. I was blogging about ethics. I was going into tidy journalistic fury over the shock (shock!) of being taught to abort. I was standing outside of clinics. I was glad that I had a good upbringing and a sound education. It made me strong in the culture war, and I was loving the fight!

A few months into my second year, I began to discover that the fight wasn't straightforward. One of the pro-life M1s I was hoping to groom for the new head of the pro-life group didn't want to lead because she'd had an abortion. She didn't think the group was going about things "the right way" (whatever that meant). The conversation was awkward--I remember that neither of us stood, and that there was another M1 there (moral support for the M1 I'd asked?) standing as well, silently watching us. I stammered an "all right, I'd love whatever help you can give me." I ended up not seeing her much after that, and I moved on in the semester.

Later that year, I saw on the schedule that we had a lecture on "Abortion: Spontaneous, Missed, Threatened, Therapeutic." I steeled myself that morning and tucked my little plastic fetal model into my pocket. I look back on that morning and see it as a little theatrical, but at the time it was genuine. I felt like I was headed into the mouth of the beast, where impressionable, vaguely liberal college grads were taught that abortion was part of medicine.

Credit: prieststuff

I sat in my usual spot. One of the other Catholic students sat next to me. The lecturer began to talk about elective abortion. I fingered my fetal model and felt powerless. All my classmates were hearing this as if it were just another way to manage just another condition.

On a whim, I pulled out the model and passed it to the Catholic sitting next to me. She looked at it for a long several seconds, then made as if to hand it back to me. "No, pass it that way," I said. She looked as if she didn't know what to do, then reached across the few empty seats between herself and the next person. I signaled to that person to keep passing it.

I didn't get it back at the end of the class. I'd watched it travel around the room for a few minutes, but then I'd gone back to listening about threatened AB.

It was several weeks later (I'd completely forgotten about the entire thing) when I received a concise email from one of the School of Medicine's administrators--the lawyer who gave us a lecture on how we could get kicked out for unprofessional behavior. She asked if I had time to meet with her and the dean that week.

My blood pressure spiked at first, but I reassured myself: I'm a good student, I haven't done anything wrong. Perhaps she wants to ask me about someone else? I gave her a time and showed up to the meeting. It was Holy Thursday.

The instant that I walked into the room and saw her face, I knew that I was the one in trouble. Her expression was stony, her voice was clipped. The dean sat in a chair by her desk, only marginally less terrifying.

I don't remember all the exact words. She asked me whether I passed around a model of a fetus during the lecture. I said yes, I had. She told me that not only was that disruptive in the classroom, but it had upset several of my peers and that one or two had come to her crying about it. I instantly regretted so thoughtlessly picking my pro-life trinket out of my pocket and passing it around during class! I already learned that there were post-abortive women around me! Why hadn't I thought of them? What a painful thing I had done! I'd been warned that I was going about things the wrong way and I hadn't done anything about it!

Credit: timmatkin

From the shame of being in a disciplinary position on top of the distress I felt at what I'd done to my peers, I started to cry. "It hurts me," I stuttered, "to think that I caused someone pain." I offered to apologize in some anonymous way to the girls I'd hurt. I was declined. I spent a miserable rest of the day.

The next day, I attended the Good Friday service. Christ on the cross looked as miserable as I felt. "And as miserable as I made those girls," I muttered. I felt like Pilate, more than I ever had in the dozens of times I've said "His blood be upon us and upon our children" and "Crucify Him" on Palm Sunday.

That day I had a small change of heart. I realized that everything I lacked (poise, foresight, compassion, circumspection, thoughtfulness, and a sense that I was on the right side of things) I truly lacked. I wasn't just feeling a temporary loss of those virtues: I never had them to begin with. So I asked Christ for all his virtues, to replace all my disasters. It was a beautiful Good Friday, one I will never forget. Even now at Mass, when I go to communion, I often think of that Good Friday and ask Christ to give me everything of His soul, including all his virtues.

But this episode had one very unfortunate effect: it made me afraid. It was not until the beginning of my fourth year that I began to uncase myself from that cold fear that I would once again hurt someone or bring on the shame of that terrible disciplinary meeting. I realize now why I was so afraid. I stopped short in accepting something of Christ's cross: His courage.

Now I behold the wood of the cross and recall my misery. I know that I have made lots of scandalous mistakes that have caused a great deal of pain. So I ask Christ to replace my viciousness with His perfections. And even though I'm a liability to His glory, He asks that I fight for him, and gives me His courage.

Now, as a resident that fearlessly but happily refuses to prescribe, I am a warrior. But the strength I fight by is not mine. So behold, the wood of the Cross, on which our Savior poured out all His virtues for us and provided an almost-irrational courage for us, even though we're such disasters.

---

P.S.: It was recently pointed out to me that if a person is so fragile as to cry at the sight of a fetal model, he or she is in need of some serious healing, and that confronting that person with the truth may have had a good effect. While I agree, it's still not the best way to show someone the truth. And even if the "disruptive" thing wasn't true (because the lecture was teleconferenced from forty miles away), I still think I acted carelessly and hurt someone. May God bring some good out of it! Please pray for the people that I hurt that day, because I'm sure their souls are deeply wounded from whatever in their past made them so upset at the sight of my little plastic fetus.

P.P.S.: By the way, one of the first things I stuck in my new resident coat was a new and improved fetal model. I showed it to probably sixty people in my first month of residency. I did it calmly and gently, after considering whether it was the right way to show the truth or not. And I haven't regretted it yet.

Intern Happenings (and four months in review)

In the past four months, I reupholstered some Craiglisted chairs (previously tiger-print), made some curtains, wrecked a car, bought another car, and survived (almost) to the end of the "dark time." This post starts silly, but concludes with big thoughts on how things are changing through my intern year.

BEFORE

When I visited the house where these tiger-print chairs were, it worked in her scheme. Some people can pull things off that I could never make work. So I reupholstered them with an on-sale green curtain fabric from JoAnn. When I bought the chairs, I knew I was taking on a Project. I thought to myself, "it's okay, I'll bang it out in a weekend and be done with it." This was a big mistake. Now that my time is more precious than it has ever been (I pulled another 90-hour week last week), I think I might have other people do my little projects so that I can focus on bigger things.  I learned that upholstery is like surgery: it's easy to do "well-enough" but much harder to do beautifully. This picture doesn't quite hide the fact that my corners look like badly made bedsheet corners. The original owner had done the tiger-print upholstery herself and it looked perfect.

AFTER

Don't let this quick succession of pictures fool you. It took at least four months from start to finish. I kept dragging my feet at the last part, which was to screw the reupholstered seats back onto the chair frames. It was so hard and I developed an almost subconscious block to doing it. I'd do everything else on my to do list, and then (oops!) I wouldn't have time to fix the chairs. The item "Screws" hung out on my iphone Tasks list for ages.

Aaaaaaand I wrecked another car. I was changing from nights to days and forgot to set an alarm. I woke up to a text from my second year asking where I was. It was a nightmare come true. In two minutes I was out the door and in the car and rushing to work. I rushed a little too much! The accident wasn't wholly my fault, but if I hadn't been stressed, I bet I could've avoided it. I ran into a tree (swerved to miss the other car, who went off). The tree won.

The story of me buying the other car is funny, because it highlights how my crazy busy schedule only permits the extreme way of doing ordinary adult things like car-buying. My dad (630 miles away) discovered that you can buy cars from rental car companies. This is nice because the car company has a vested interest in the car working and being easy to maintain, so you know you're not getting a total lemon. It's also nice because you can drive the car for a brief period before you buy it.

So they tried to find me a car from a rental car company. We failed several times because the cars they found kept being driven to unplanned locations (like Vegas) by the people who were currently renting them. It was like requesting a hold on a library book, but then you find out that the book was returned to a library in another state.

We finally had a car that showed up where it was supposed to (in the same city as I was!). The only time I could pick it up was between work (6pm leave-time) and flying out for Christmas (10pm flight). So after work I took an Uber to the rental lot, signed my life away in the typical ritual of car-buying, drove off with a new car, then left the car in my apartment lot while I took a taxi to the airport for Christmas. It was a bizarre experience.

The answer to everything.

I have now driven 42 hours in that car and am pleased with it. It's a lot of car for a person trying to live poverty (it's got a back-up camera and a fancy screen that tells you stuff), but I just hope I don't wreck it by the time I get to tell you about the next few months.

A quickie update on some things in my last blast: neither of the illustrators were interested in my children's books, but that's okay. Again, I'm constantly learning to triage my projects. One of the patent proposals didn't work, but the other is in provisional status.

I'm also flying a lot this year: a friend's wedding, home for Christmas, to Chicago to film a video for NFP-only applicants to residency, to a conference in Toronto, and to another friend's shower (and again for her wedding). Attempting to plan a bridal shower (sorry, Mom) while also planning a video and submitting a poster to two things was a lot.

In addition, I got the "dark schedule," the intern schedule with four consecutive months of L&D, then nights, then MFM, then L&D. It's aptly named, as these four hard months coincide with January and February, the peak months for burnout. I'm now on vacation and feeling a little more human. I know the second year and the third year who got this schedule, and they changed. Fatigue changes you; you get snarkier, and sometimes speak badly about patients. You complain more. You talk about other people behind their backs. You search for any comfort--in food, in entertainment....

I don't want to change, but I see myself doing it. Is my wrecked car a symbol of something destroyed in me? Is my lovely dining room a symbol of something superficially nice in me? More on this to come. For now, I'll stick with frivolous updates on chairs and cars. Yay upholstery!